A critique on physicians as managers in the healthcare sector: coping with contradictions in managerial and medical logics

Cregård, Anna

Förvaltningshögskolan, Göteborgs universitet.

Eriksson, Nomie

University of Skövde, School of Technology and Society. (Medarbetarskap och Organisatorisk resiliens (FORE))

2012 (English)Conference paper, Published paper (Refereed)

Abstract [en]

In the healthcare sector the physicians more and more often become managers, in Sweden as well as in many other countries. This is a global trend, which is motivated by better quality, higher efficiency and an increased possibility to control professional actors in the organization. Managing professions are perceived as difficult for many reasons and the appointment of physicians as managers is supposed to solve this problem.

Our aim is to critically discuss the appointment of physicians on traditional management positions in healthcare sector and what it might result in. We recognize that there are positive effects, but they do not align with the rhetoric concerning these appointments. We also discuss an alternative way of organizing the management of professionals in healthcare organizations.

We use two theoretical concepts to discuss this phenomenon: principles of control and shift in trust. The concepts are used to categorize and analyze our empirical data, which consist of deep interviews with 15 physicians and nurses, five focus groups consisting of physicians (managers) and five texts on the relationship between politics, administration and professions, written by physicians (managers) in management training. We also develop the concepts of medical and managerial logics.

Our respondents recognize the principles of control as rational, and they perceive them as important. But there are contradictions between medical and managerial logics. The management discourse alter the care and raises questions they themselves cannot answer, for example “Is it right to treat people who themselves are responsible for their sickness”? They also discuss medical concepts as being altered, for example the course of treatment being completed. Nowadays the concepts concern strictly medical issues, which is not necessarily good in a health perspective. The shift in trust concerns four levels: the trust between individuals, between professional groups, between organizational levels and between the whole society and the healthcare system. For example the respondents mean that the staff sometimes are questioning if the physician as a manager have enough medical day-to-day practice, and there are examples where the staff try to steer away complicated surgery from their superior. The staff also question if he or she is competent enough in management. Another example is that there is a risk of a decrease in trust in the healthcare system as a whole. Gains and losses are described in monetary terms, and the business language is not recognised as appropriate in this kind of organization.

In our conclusions we discuss that there are a chance that appointing physicians on administrative assignments might bring the ears of the colleagues, increased transparency in the everyday care and perhaps a better understanding of overall decisions. But there are also some negative effects and risks – which we discuss using the concepts of medical and managerial logics. Appointing physicians as managers result in two contradicting logics pressed into one individual, who are supposed to handle the contradictions on an individual basis. For example, this means that the principles of ethics will collide with a different rhetoric – from the rationality of medical logics (with equivalence principle and loyalty to the patient) to the rationality of business logics (with cost minimization, production maximization and loyalty to the organization). We summarize the risks below.

—Risk 1: When the physician loses skill, or perceived as less competent than earlier, there will be consequences for both the physician and the patient.

—Risk 2: When trust in the physician manager decreases, he/she will not gain support by other physicians.

—Risk 3: When the trust between different levels, groups and individuals in the organization decreases, it will also decrease for care in general.

—Risk 4: When important values in the service domain are pushed aside, this will favour the values in the administrative domain (efficiency over quality).

Finally we discuss other ways of handling uncontrollable professional organizations, for example by refining administrative and medical roles, by establishing medical management as a speciality within medical education, and by re-strengthen the medical logic. Most important is to alter and nuance the discourse around physicians as managers.

Place, publisher, year, edition, pages

International Research Society for Public Management (IRSPM) , 2012. p. 1-14